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Making the Right Decision – Ethical and Legal Considerations (Reading & Sharing re: End-of-life)

Scope and Standards of Practice – End of life Care

  1. Structure and processes of care: the composition and qualifications of the interdisciplinary team and define how the team should collaborate with patients and families.
  2. Physical aspects of care: management of physical symptoms such as pain, fatigue, anxiety, and others.
  3. Psychological and psychiatric aspects of care: assessment of the psychosocial needs of patients and families. the requirement for bereavement support is included in this domain.
  4. Social aspects of care: focus on leveraging family strengths and social support mechanisms to alleviate family stress.
  5. Spiritual, religious, and existential aspects of care: emphasizes the roles of the members of the interdisciplinary team, especially the chaplain, in recognizing and addressing spiritual and existential distress. Specifically, the competency of all team members in understanding and supporting the religious practice preferences of patients and families is stressed.
  6. Cultural aspects of care: describes cultural competence and defines processes for the provision of culturally sensitive care.
  7. Care of the patient at the end of life: Highlights the importance of providing multidimensional interdisciplinary end-of-life care for patients and their families, which includes educating them and building them through the dying process.
  8. Ethical and legal aspects of care: addresses advance care planning, ethics, and legal aspects of care. The role of the interdisciplinary team in broaching end-of-life conversations and documenting patients’ preferences is stressed. Consultation with ethics committees and legal counsel is also emphasized.

Ethical Principles:

  • Autonomy: The right to make decisions for oneself. Autonomy is the principle that underpins the practice of informed consent
  • Beneficence: The principle of doing the most good; acting kindly and charitably
  • Confidentiality: The expectation that the patient’s private information will not be disclosed to anyone without the patient’s consent
  • Justice: The promotion of good for all
  • Non-maleficence: Doing no harm
  • Paternalism: Restricting the liberty or rights of another, seemingly for the person’s own good
  • Truthfulness: Providing information with honesty and integrity

When ethical dilemma occurs… …

  1. Determine the medical facts of the case;
  2. Identify the values, concerns, and recommendations of the clinicians;
  3. Identify the values, concerns, and preferences of the patient or designated surrogate;
  4. Identify the ethical issues at hand;
  5. Consider any practical issues that may have bearing on the case.

Moral Distress – A negative feeling that emerges when an individual knows the morally correct action to take but feels unable to take that action due to hierarchical or institutional barriers.

***Frequently facing ethical dilemmas can cause moral distress in the health care professionals.***

***Repeated exposure to moral distress may contribute to nurse burnout.***

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